{
  "abstract": "Objectives The aim of this study was to prioritise a set of indicators to measure World Health Organization (WHO) quality-of-care standards for small and/or sick newborns (SSNB) in health facilities. The hypothesis is that monitoring prioritised indicators can support accountability mechanisms, assess and drive progress, and compare performance in quality-of-care (QoC) at subnational levels.Design Prospective, iterative, deductive, stepwise process to prioritise a list of QoC indicators organised around the WHO Standards for improving the QoC for small and sick newborns in health facilities. A technical working group (TWG) used an iterative four-step deductive process: (1) articulation of conceptual framework and method for indicator development; (2) comprehensive review of existing global SSNB-relevant indicators; (3) development of indicator selection criteria; and (4) selection of indicators through consultations with a wide range of stakeholders at country, regional and global levels.Setting The indicators are prioritised for inpatient newborn care (typically called level 2 and 3 care) in high mortality/morbidity settings, where most preventable poor neonatal outcomes occur.Participants The TWG included 24 technical experts and leaders in SSNB QoC programming selected by WHO. Global perspectives were synthesised from an online survey of 172 respondents who represented different countries and levels of the health system, and a wide range of perspectives, including ministries of health, research institutions, technical and implementing partners, health workers and independent experts.Results The 30 prioritised SSNB QoC indicators include 27 with metadata and 3 requiring further development; together, they cover all eight standard domains of the WHO quality framework. Among the established indicators, 10 were adopted from existing indicators and 17 adapted. The list contains a balance of indicators measuring inputs (n=6), processes (n=12) and outcome/impact (n=9).Conclusions The prioritised SSNB QoC indicators can be used at health facility, subnational and national levels, depending on the maturity of a country’s health information system. Their use in implementation, research and evaluation across diverse contexts has the potential to help drive action to improve quality of SSNB care. WHO and others could use this list for further prioritisation of a core set.",
  "authors": [
    {
      "affiliations": [
        "Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Louise T Day"
    },
    {
      "affiliations": [
        "Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"
      ],
      "name": "Lara M E Vaz"
    },
    {
      "affiliations": [
        "Ariadne Labs, Brigham and Women’s Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA",
        "Division of Global Health Equity and Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Katherine E A Semrau"
    },
    {
      "affiliations": [
        "Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Sarah Moxon"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine and Colorado School of Public Health, Aurora, Colorado, USA"
      ],
      "name": "Susan Niermeyer"
    },
    {
      "affiliations": [
        "Global Health, Save the Children Federation, Washington, District of Columbia, USA"
      ],
      "name": "Neena Khadka"
    },
    {
      "affiliations": [
        "John Snow International, Arlington, Virginia, USA"
      ],
      "name": "Tamar Chitashvili"
    },
    {
      "affiliations": [
        "University of Washington, Seattle, Washington, USA"
      ],
      "name": "Gregory C Valentine"
    },
    {
      "affiliations": [
        "Jhpiego Corporation, Baltimore, Maryland, USA"
      ],
      "name": "Mary Drake"
    },
    {
      "affiliations": [
        "Vermont Oxford Network, Burlington, Vermont, USA",
        "University of Vermont Larner College of Medicine, Burlington, Vermont, USA"
      ],
      "name": "Danielle E Y Ehret"
    },
    {
      "affiliations": [
        "Department of International Health, Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, Maryland, USA"
      ],
      "name": "Ashley Sheffel"
    },
    {
      "affiliations": [
        "Department of International Health, Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, Maryland, USA"
      ],
      "name": "Emma Sacks"
    },
    {
      "affiliations": [
        "Public Health Institute contractor with the United States Agency for International Development, Washington, Virginia, USA"
      ],
      "name": "Leah Greenspan"
    },
    {
      "affiliations": [
        "Public Health Institute contractor with the United States Agency for International Development, Washington, Virginia, USA"
      ],
      "name": "Theresa R Shaver"
    },
    {
      "affiliations": [
        "Public Health Institute contractor with the United States Agency for International Development, Washington, Virginia, USA"
      ],
      "name": "Lily Kak"
    },
    {
      "affiliations": [
        "Health Section, UNICEF, New York, New York, USA"
      ],
      "name": "Tedbabe Degefie Hailegebriel"
    },
    {
      "affiliations": [
        "Health Section, UNICEF, New York, New York, USA"
      ],
      "name": "Gagan Gupta"
    },
    {
      "affiliations": [
        "Jhpiego Corporation, Baltimore, Maryland, USA"
      ],
      "name": "Kathleen Hill"
    },
    {
      "affiliations": [
        "Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK",
        "University of the Western Cape School of Public Health, Bellville, South Africa"
      ],
      "name": "Debra Jackson"
    }
  ],
  "title": "Global prioritised indicators for measuring WHO’s quality-of-care standards for small and/or sick newborns in health facilities: development, global consultation and expert consensus",
  "uid": "bc1d18d6-8875-5a31-8a55-49ef65f31e26"
}